COLONIC INVESTIGATIONS IN THE ELDERLY - COLONOSCOPY OR BARIUM ENEMA

Colonoscopy (CS) is currently considered the best diagnostic procedure for colonic imaging. The objectives of this multicentric study were t o assess whether CS or simple contrast barium enema (SCBE) has the bes t effectiveness and tolerance in the elderly (over 80 years old). Exce pt in cases of emergency, 67 elderly patients from 3 centers were rand omized among three diagnostic strategies: CS, SCBE or barium enema + r ectosigmoidoscopy (BERS). CSs were generally carried out after polyeth ylene-glyco( (PEG) cleansing, and barium enemas after enema cleansing. The diagnostic effectiveness of the three strategies was nor signific antly different: a colonic abnormality was found in CS, SCBE, BERS gro ups in 65, 56 and 71% of the cases, respectively. No other investigati on was needed in 61 to 76% of cases, and, on the basis of the explorat ion, final therapy was modified in less than 22% of cases. Overall cle ansing quality was significantly better with barium enema (84.1%) than with CS (57.0%; p<0.05). This was explained by a poor tolerance to PE G intake, which led to 28.2% of adverse effects, compared with 7.1% af ter enema preparation (p<0.05). This resulted in a significantly highe r failure rate of complete colonic exploration with CS (48%) than with barium enema (9%; p<0.001). In conclusion, the effectiveness of the t hree diagnostic strategies is similar in the elderly. However, due to a better acceptance of the enema preparation, and to a better success rate of complete exploration, SCBE should be preferred to investigate colonic symptoms when the above preparations are used.